Effects of OT-Based Interventions to Reduce Perceived Burden and Depression of Caregivers of Older Adults With Dementia

Abstract

Date Presented 03/26/20

This is a randomized controlled trial (N = 37) in which individualized OT interventions were provided for three months to support caregiving challenges faced by caregivers of people with dementia. The interventions included illness education, training for safe transfers, medication and appointment organization, exercise methods, and more. These were effective in decreasing depression and mental fatigue and increasing confidence to provide for the next six months, despite the worsening cognitive status of their care recipients.

Primary Author and Speaker: Turquessa Francis

Additional Authors and Speakers: Leanna Grandolph

Contributing Authors: Machiko Tomita, Kristen Binkewicz, Kelly Dinatale, Victoria Anderson, Leanna Grandolph, Deborah Tse, Sara Vasisko

PURPOSE: In 2018, 16.3 million families and friends called informal caregivers (ICGs) provided 18.5 billion hours of unpaid care to people with Alzheimer’s and other dementias, which valued about $234 billion.

80% of older adults with dementia receive help with daily activities, in contrast to 20% of older adults without dementia. ICGs of individuals with cognitive decline experience high rates of burden and depression. Although caregiver support groups exist, tangible supports are rarely provided. The purpose of the study was to provide Occupational Therapy (OT) related interventions for challenges that ICGs are facing to reduce negative effects of caregiving. We hypothesized that provision of OT interventions would reduce caregiver burden, depression and fatigue and improve caregiving confidence and positive aspects of caregiving.

DESIGN: This was a 3-month randomized control trial, with pretest, posttest, and follow-up assessments administered in ICG’s or care recipient (CR)s’ homes. Participants (N=37) consisted of 22 treatment [G1] and 15 control [G2]) who were ICGs of participants to one of three Programs of All-inclusive Care for the Elderly (PACEs) in Western New York. They were recruited by the PACEs. CRs were 65 years or older and had cognitive decline needing a nursing home level of care, but were living in the community. Challenges were identified through in-depth interviews and interventions to support these challenges were brainstormed and presented to ICGs. We provided interventions and follow up for 3 months to G1 and educational material only to G2. We assessed them three times (baseline, 1.5 and 3 months).

METHOD: Measurement instruments were the Zarit Burden Interview (ZBI), Center for Epidemiological Study-Depression (CES-D), Positive Aspects of Caregiving (PAC), physical and mental fatigue, and confidence to provide care at present and for six months. Analytical method was ANCOVA.

RESULT: OT interventions consisted of training (including safe transferring, medication management, appointment scheduling, home modifications), providing information regarding support groups and exercise, and assisting in communication with healthcare providers.

The two groups were comparable (p>.05) in all demographic characteristics. However, initial GDS for CRs was much worse for the treatment group (p=.016); therefore, initial and 3 and 6 month assessments showed the treatment group was worse than the control group for most outcome measures. Adjusting to the baseline difference in scores, at 3 months, G1 was better than G2 on depression (p=.036), mental fatigue (p=.011) and confidence to care for 6 months (p<.001). ZBI for G1 was lower than G2 without statistical significance. G2 had tendencies to improve at 1.5 months but declined in all measures at 3 months. In total, 60 interventions were provided and 34 of them were implemented (56.7%). Of them, 82.4% were satisfied (Very satisfied, 20.6%; Satisfied, 47.1%; somewhat satisfied, 14.7%), 14.7% did not answer, and 0.3% were not satisfied.

CONCLUSION: We conclude that an education only intervention may be effective for a short period, about 1.5 months, but the effects faded at 3 months. Our individualized and accepted OT support for caregivers was effective to improve the caregiving situations of G1 at 3 months, especially in increasing confidence to care for six months. We encourage not only studies with larger sample sizes for further research, but also the idea of including OTS’ support for caregivers in an OT curriculum to increase appreciation of a family-centered health care approach. This study calls for (1) a policy to pay more attention to caregivers’ physical and mental health and (2) OT’s new role in a family-centered health care model.

References

Alzheimer’s Caregiving. National Institute of Aging. (n.d.). Retrieved from https://www.nia.nih.gov/health/alzheimers/caregiving

DiZazzo-Miller, R., Winston, K., Winkler, S. L., & Donovan, M. L. (2017). Family Caregiver Training Program (FCTP): A randomized controlled trial. American Journal of Occupational Therapy, 71, 7105190010. https://doi.org/10.5014/ajot.2017.022459

Piersol, C. V., Canton, K., Connor, S. E., Giller, I., Lipman, S., & Sager, S. (2017). Effectivenessof interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders: A systematic review. American Journal of Occupational Therapy, 71, 7105180020. https://doi.org/10.5014/ajot.2017.027581